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                                                                                                                CHRONIC AND DISABLING CONDITIONS
                                                                                               January 2000




                                                                                                                                                   C H A L L E N G E S
   Heart Disease
   A disabling yet                                                                                NATIONAL
                                                                                               ACADEMY ON AN
   preventable condition                                                                        AGING SOCIETY



   Almost 18 million people—7 percent of all Americans—have heart disease. More than




                                                                                                                                                   F O R
   half of the population with heart disease is under age 65. Older people are affected
   by heart disease to a much greater extent, however. The elderly are more likely to
   have coronary heart disease, commonly known as a heart attack or chest pain, which




                                                                                                                                                   T H E
   is more debilitating than other types of heart disease. Yet many forms of heart dis-
   ease are largely preventable. Controlling conditions, such as high blood pressure and
   diabetes, and engaging in a healthy lifestyle can reduce the risk of heart disease.




                                                                                                                                                   2 1
                                           S
                                                ome people with heart disease do not have any diffi-
   HEART                                        culty on a daily basis. On the whole, however, those




                                                                                                                                                    S T
                                                with heart disease are more limited in their activities,
   DISEASE                                 including work.
   LIMITS




                                                                                                                                                   C E N T U R Y :
                                           s   Coronary heart disease is the leading cause of premature,
   ACTIVITY                                    permanent disability in the U.S. labor force.
   Proportion of people
   limited in activities
   of daily living                         s   Labor force participation is lower for the population with
                                               heart disease compared to the population without it.
   WITHOUT HEART DISEASE
   WITH HEART DISEASE                      s   Workers who are limited by heart disease earn less than
   WITH CORONARY HEART DISEASE
                                               workers without heart disease.
              50
    PERCENT




              40
              30
                              32
                                           Heart disease is particularly limiting
              20        25
              10                           for older adults
               0   9
                       51–61               Differences in activity level for those with and without heart
                        AGE                disease are substantial. Adults with heart disease are much
              50                           more likely to have difficulties with activities of daily living,
    PERCENT




              40              49           or ADLs, such as bathing, dressing, eating, using the toilet,
              30        40
                                           walking, and getting into and out of bed. Difficulties are
              20   26                      most common among older age groups. Among those with
              10
               0
                                           coronary heart disease, about one-third of those age 51 to 61
                        70+                and about half of those age 70 and older have difficulty with
                        AGE                one or more ADL.
SOURCE: National Academy on an
Aging Society analysis of data from
the 1992 Health and Retirement Study
and the 1993 study of Asset and Health
Dynamics Among the Oldest Old.



                         N A T I O N A L   A C A D E M Y    O N   A N   A G I N G   S O C I E T Y
                                                                 s   Because educational attainment and
Who has heart disease?                                               income are often related, it is not sur-
Among the population with heart disease,                             prising that those at lower income levels
the proportions of elderly people, whites,                           are more likely to develop heart disease
and people with less education and low                               than those at higher income levels.
incomes are higher than in the general pop-
ulation. The proportion of people in these
groups is even higher for the population                             WHAT IS
with coronary heart disease (see Figure 1).
                                                                     HEART DISEASE?
s   The elderly have a higher rate of heart
                                                                     Heart disease is a type of cardiovascular disease.
    disease than any other age group.
                                                                     In addition to heart disease, the term cardiovas-
                                                                     cular disease encompasses a variety of heart con-
s   Across all age groups, rates of heart
                                                                     ditions, such as high blood pressure and stroke.
    disease in men and women are similar.
                                                                        Coronary heart disease (CHD) is caused by
    In older age groups, however, heart
                                                                     a narrowing of the coronary arteries, which
    disease strikes more men than women.
                                                                     results in a decreased supply of blood and oxy-
                                                                     gen to the heart. CHD includes myocardial
s   Whites are more likely to develop
                                                                     infarction, commonly referred to as a heart
    coronary heart disease than other races.
                                                                     attack, and angina pectoris, or chest pain. A
    Blacks, however, are more likely to die
                                                                     heart attack is caused by the sudden blockage
    from heart disease. The gap in the heart
                                                                     of a coronary artery, usually by a blood clot.
    disease death rate between blacks and
                                                                     And chest pain occurs when the heart muscle
    whites has widened since the 1980s.1
                                                                     does not receive enough blood.
                                                                        Another type of heart disease is a heart
s   Individuals with less than a high-school
                                                                     rhythm disorder, which includes rapid heart,
    education are more likely to have heart
                                                                     heart murmurs, and other unspecified disorders.
    disease than individuals with a high-
                                                                        Congestive heart failure (CHF), which is
    school education or more. The risk of
                                                                     often the end-stage of heart disease, is another
    death from coronary heart disease is also
                                                                     disease of the heart.
    much greater for the least-educated than
    for the most-educated people.2


    FIGURE 1
    Description of Three Populations
                                                                                                    POPULATION
                                                 GENERAL               POPULATION WITH             WITH CORONARY
                                              POPULATION (%)           HEART DISEASE (%)          HEART DISEASE (%)

    AGE                0–17                            27                         7                        <1
                       18-64                           61                        50                        42
                       65+                             12                        43                        58
    GENDER             MALE                            49                        48                        59
                       FEMALE                          51                        52                        41
    RACE               WHITE                           83                        88                        91
                       BLACK                           13                         9                         7
    EDUCATION          <HIGH SCHOOL                    20                        30                        34
                       HIGH SCHOOL+                    80                        70                        66
    INCOME             <$20,000                        24                        34                        36
                       $50,000+                        23                        15                        10

    SOURCE: National Academy on an Aging Society analysis of data from the 1994 National Health Interview Survey.




2           N A T I O N A L       A C A D E M Y        O N     A N    A G I N G       S O C I E T Y
              People with heart                                                 for people with coronary heart disease.
                                                                                Over three-quarters—76 percent—of the
              disease are less healthy                                          population with coronary heart disease
              Over half—61 percent—of the population                            have been hospitalized for this disease.
              with heart disease reports being in good to                         Among the population age 70 and older,
              excellent health compared to 92 percent of                        those with heart disease are more likely to
              the population without heart disease.                             use prescription drugs and other services,
              Relative to younger population groups,                            including a social worker, adult day care,
              smaller proportions of older adults general-                      rehabilitation, transportation, or Meals on
              ly report their health as good to excellent.                      Wheels, than those without heart disease.
              Regardless of age, however, adults with
              heart disease are less likely to report their
              health as good to excellent and more likely
                                                                                Family provides much of
              to report their health as fair to poor than                       the care needed by elders
              adults without heart disease (see Figure 2).
                 Individuals with heart disease are more
                                                                                with heart disease
              likely to stay in bed due to an illness or                        Two out of five people age 70 and older
                                                                                with heart disease need assistance with
                                                                                their ADLs. Spouses, children, and grand-
FIGURE 2
                                                                                children provide 65 percent of the help
Proportion of the Population Reporting Good                                     that is needed (see Figure 3). Children and
to Excellent or Fair to Poor Health, by Age                                     grandchildren also provide 70 percent of
                                                                                the assistance needed by this same group
                                GOOD TO                  FAIR TO                to perform instrumental activities of daily
                              EXCELLENT (%)             POOR (%)
                                                                                living, or IADLs, including day-to-day
AGE 51 TO 61                                                                    finances, savings and investments, and
With heart disease                   57                     43                  major decisionmaking.
Without heart disease                86                     14

AGE 70 AND OLDER                                                                     FIGURE 3
With heart disease                   51                     49
Without heart disease                78                     22
                                                                                     Caregivers of People Age 70+ with
                                                                                     Heart Disease and in Need of Help
SOURCE: National Academy on an Aging Society analysis of data from the
1994 National Health Interview Survey.                                               with Activities of Daily Living


              impairment than individuals without heart
              disease. The proportion of people with heart
              disease who report spending five or more                                                                          25%
                                                                                                                               SPOUSE
              days in bed in the past year is more than                                               35%
              twice that of people without heart disease.                                            OTHER
              Almost two million people report spending
              five or more days in bed in the past year due
              to their heart disease.
                                                                                                                       38%
              Health care service use is                                                                               CHILD


              greater for those with                                                       2%
                                                                                      GRANDCHILD
              heart disease
              Annual physician visits and hospital-
                                                                                     SOURCE: National Academy on an Aging Society analysis
              ization rates are higher for those with                                of data from the 1993 study of Asset and Health Dynamics
              heart disease compared to those without.                               Among the Oldest Old.
              Hospitalization rates are particularly high

              3           N A T I O N A L        A C A D E M Y           O N   A N     A G I N G      S O C I E T Y
                                                      heart disease. Some 76 percent of people with
    A HEALTHY                                         heart disease report that poor health was a
                                                      very important factor in their decision to
    LIFESTYLE CAN                                     completely retire. Among those without
    REDUCE THE RISK                                   heart disease, only 39 percent report poor
                                                      health as a very important factor.
    OF HEART DISEASE                                     Given the importance of health in the
    A healthy lifestyle can reduce the risk of        decision to retire, it is not surprising that
    heart disease by as much as 80 percent.3          many people with heart disease did not
    People who are not overweight, do not             want to retire. Only 16 percent of those
    smoke, consume about one alcoholic drink a        with heart disease who are completely
    day, exercise vigorously for 30 minutes a day     retired wanted to retire, whereas 47 percent
    or more, and eat a low-fat, high-fiber diet       of those without heart disease who are
    have the lowest risk for heart disease. Heart     completely retired wanted to retire.
    disease is largely preventable by virtue of a        Satisfaction with retirement is much lower
    healthy lifestyle—it doesn’t have to be the       for those with heart disease than for those
    number one killer of Americans.                   without. While only one-fifth of those with
                                                      heart disease are very satisfied with their
                                                      retirement, almost half—46 percent—of
                                                      those without the disease are very satisfied.
People with heart disease
are more likely to become                                   FIGURE 4
depressed                                                   Retirement Status of People Age 51 to 61
Among 51 to 61 year olds, the proportion of
those with heart disease that experienced                              10%              11%
four or more symptoms of depression in the                     HOMEMAKER                COMPLETELY RETIRED

past week—14 percent—is almost three                                                          6%
times that of those without heart disease—5                                                   PARTLY RETIRED

percent. The impact of depression on people
                                                                              73%
with heart disease can be severe, particularly                             NOT RETIRED
for those who have a heart attack.
Depression is a significant predictor of death
                                                                   WITHOUT HEART DISEASE
12 months after experiencing a heart attack.4
Differences in self-reported emotional health
                                                                  14%                     25%
status are also great between those with and                HOMEMAKER                     COMPLETELY RETIRED
without heart disease. Among 51 to 61 year
olds, over one-third—34 percent—of those
                                                                                              6%
with heart disease, compared to just 16 per-                                  55%
                                                                                              PARTLY RETIRED
                                                                           NOT RETIRED
cent of those without heart disease, rate their
emotional health as fair to poor.
                                                                       WITH HEART DISEASE

Heart disease affects                                             16%                     30%
                                                            HOMEMAKER                     COMPLETELY RETIRED
retirement decisions
There are striking differences in the retire-                                48%
ment status of people age 51 to 61 with and                               NOT RETIRED         6%
without heart disease (see Figure 4). Heart                                                   PARTLY RETIRED

disease appears to be a factor that pushes
                                                               WITH CORONARY HEART DISEASE
people toward early retirement, and reduces
satisfaction with retirement.                           SOURCE: National Academy on an Aging Society analysis of data from the
   Health is often a strong factor in retire-           1992 Health and Retirement Study.
ment decisions, particularly for those with

4          N A T I O N A L    A C A D E M Y     O N   A N     A G I N G    S O C I E T Y
Coronary heart disease                            FIGURE 5

is the leading cause of                           Employment Status of the
                                                  Working-Age Population With
premature, permanent                              and Without Heart Disease
disability in the U.S.
                                                                                 WITHOUT HEART DISEASE
labor force                                                                      WITH HEART DISEASE
                                                             90
Disability for U.S. workers with heart dis-
                                                             80
ease is high.5 They are more limited in                                 78
                                                             70                74
the type or amount of work they can do




                                                  PERCENT
                                                                                             70
compared to those without heart disease.                     60
More than one-fifth—22 percent—of                            50
                                                                                                   51
workers with heart disease have work lim-                    40
itations, compared to just 8 percent of                      30
workers without heart disease.                               20
   Coronary heart disease is particularly                    10
disabling. Among workers age 51 to 61,                        0
for example, some 44 percent of those                                    18–44               45–64
with heart disease and 56 percent of                                                AGE
those with coronary heart disease report              SOURCE: National Academy on an Aging Society analysis
that their condition is the cause of a lim-           of data from the 1994 National Health Interview Survey.
itation in the type or amount of paid
work they can do. Almost 500,000 people
of working age who are not working              Workers with heart
report that coronary heart disease causes
limitations in their ability to work.
                                                disease earn less
Coronary heart disease accounts for 19          Differences in monthly earnings between
percent of disability allowances by the         workers with and without heart disease
Social Security Administration.6                are fairly large, particularly among older
                                                adults who are limited in their ADLs (see
                                                Figure 6).
Labor force participation
is lower for the population                       FIGURE 6
with heart disease                                Median Monthly Earnings
Employment rates for those with and with-         for Workers With and Without
out heart disease are strikingly similar for      Heart Disease
younger age groups. Differences surface
among older populations, however. Only                                         WITHOUT HEART DISEASE
                                                                               LIMITED BY HEART DISEASE
about half of 45 to 64 year olds with heart                  3,000
disease work, compared to 70 percent of
                                                             2,500
people in that age group who do not have
                                                  DOLLARS




                                                             2,000                        $2,417
heart disease (see Figure 5).
                                                                                                   $1,998
  Workers with heart disease miss more                       1,500
                                                                      $1,534
work compared to workers without the dis-                    1,000             $1,369
ease. Some 12 percent of workers age 18 to                    500
64 with heart disease compared to only 6
                                                                  0
percent of workers in that age group with-
                                                                         18–44                45–64
out heart disease report missing a day or
                                                                                    AGE
more of work in a two-week period. Some
                                                      SOURCE: National Academy on an Aging Society
140,000 adults age 18 to 64 report missing            analysis of data from the 1993 panel of the Survey
a day or more of work in a two-week peri-             of Income and Program Participation.
od due to heart disease.

5       N A T I O N A L   A C A D E M Y   O N   A N         A G I N G   S O C I E T Y
              People with heart disease                                                             FIGURE 7
              are less satisfied                                                                    Proportion of People Age 51 to 61
              People with heart disease are less satisfied                                          Satisfied with Various Aspects of Life
              with their “life as a whole” than those with-
                                                                                                                                     WITHOUT HEART DISEASE
              out heart disease. Factors that may contribute                                                                         WITH HEART DISEASE
              to this difference include health and finances;                                                 100




                                                                                                    PERCENT
              people with heart disease are much less satis-                                                   80    88
                                                                                                                                                   96
              fied than those without heart disease with                                                                             78                 91
                                                                                                               60
                                                                                                                          66              64
              respect to both factors (see Figure 7).                                                          40
              However, this is not surprising given that                                                       20
              individuals with heart disease are, in general,                                                  0
              less healthy and less wealthy than individuals                                                        PHYSICAL       FINANCIAL      LIFE AS A
              without heart disease. For example, among                                                              HEALTH        SITUATION       WHOLE
              51 to 61 year olds, the median net worth for                                          SOURCE: National Academy on an Aging Society analysis of
              those with heart disease is $69,775, compared                                         data from the 1992 Health and Retirement Study.
              to $100,000 for those without heart disease.

              1. Centers for Disease Control and Prevention. (1998). Trends in ischemic
              heart disease death rates for blacks and whites—United States, 1981–1995.
              Mortality and Morbidity Weekly Report; 47(44): 945–949.
                                                                                                    ABOUT THE DATA
              2. American Heart Association. (1998). 1999 Heart and Stroke Statistical              This Profile presents descriptive data about
              Update. Dallas, TX: American Heart Association.                                       people who reported having any of the fol-
              3. Hu, F. (1999). Findings from the Nurses’ Health Study presented at the             lowing types of heart disease: coronary heart
              72nd Scientific Sessions of the American Heart Association, Atlanta, GA,
              November 8.                                                                           disease, heart rhythm disorders, and other
              4. Kaufmann, M., J. Fitzgibbons, E. Sussman, J. Reed, J. Einfalt, J. Rodgers,         diseases of the heart. Unless otherwise noted,
              and G. Fricchione. (1999). Relation Between Myocardial Infarction,                    the data are from four national surveys of the
              Depression, Hostility, and Death. American Heart Journal; 138(3): 549–554.
                                                                                                    community-dwelling population in the United
              5. American Heart Association. (1998).
                                                                                                    States. The 1994 National Health Interview
              6. Ibid.
                                                                                                    Survey (NHIS), conducted by the National
                                                                                                    Center for Health Statistics, provides data for

ABOUT THE PROFILES                                                                                  the entire population, including children. The
                                                                                                    1993 panel of the Survey of Income and
This series, Challenges for the 21st Century: Chronic and Disabling                                 Program Participation (SIPP) was conducted
Conditions, is supported by a grant from The Robert Wood                                            by the U.S. Bureau of the Census, and pro-
Johnson Foundation. This Profile was written by Lee Shirey with                                     vides data for the population age 18 to 84.
assistance from Greg O’Neill and Laura Summer. It is the third                                      Wave 1 of the Health and Retirement Study
in the series. Previous Profiles include:                                                           (HRS) provides information on a population
                                                                                                    age 51 to 61 in 1992. Wave 1 of the study of
1. Chronic Conditions: A challenge for the 21st century
                                                                                                    Asset and Health Dynamics Among the Oldest
2. Hearing Loss: A growing problem that affects quality of life
                                                                                                    Old (AHEAD) provides information about
The National Academy on an Aging Society is a Washington-                                           respondents age 70 and older in 1993 and
based nonpartisan policy institute of The Gerontological                                            1994. Both the HRS and AHEAD data sets
Society of America. The Academy studies the impact of demo-                                         were sponsored by the National Institute on
graphic changes on public and private institutions and on the                                       Aging and conducted by the Institute for
economic and health security of families and people of all ages.                                    Social Research at the University of Michigan.




                                              NATIONAL ACADEMY ON AN AGING SOCIETY
                                              1030 15th Street NW, Suite 250, Washington, DC 20005
                                              PHONE      202-408-3375             FAX   202-842-1150
                                              E - MAIL    info@agingsociety.org                 WEBSITE         www.agingsociety.org



              6              N A T I O N A L             A C A D E M Y             O N        A N     A G I N G           S O C I E T Y

				
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